What makes a nurse choose to take the hospice route? Furthermore, what makes some who enters the healthcare and nursing profession more prone to taking this course in their career—are there some nurses who are meant to be or “cut out for” working with hospice cases? The question about what makes someone want to enter the hospice profession within nursing has been answered in some scholarly articles and they will be discussed here. The topic of studies on a nurse’s choice to enter the hospice field  were conducted to resolve was whether nurses who choose to specialize in hospice care possess specific characteristics that both serve as predictive variables of their choice in specialty as well as distinguish them from their peers who elect other specialties. Specifically, Gaydos (2004) was interested in determining whether nurses’ personal histories compel them to pursue hospice nursing. Gaydos (2004) posited that the hospice nurse brings a “causal past” to bear upon his or her career choice when compared with other nursing specialties (p. 17).

The problem is an important one for the field of nursing to study because the causal past of the nurse and the causal past of the patient intersect in a particular manner to affect healing and other clinical outcomes. While it is evident that neither the causal past of the nurse nor the patient can be altered, increasing awareness in both the nurse, patient, and the general public regarding the effects of the causal past and the characteristics of personality and interest that they have evoked in the nurse and patient may promote more effective healing, even in cases where a patient is expected to die.

The purpose of the study was to determine whether hospice nurses share any causal past experiences in common that shape their personality attributes and their career choices. As Gaydos (2004) articulated, “Identification of patterns in the causal past of nurses may help to uncover the meaning of nursing in the lives of nurses” (p. 17). By extension, Gaydos (2004) explained, the results of the study “may then be used in efforts to attract, educate, socialize, and retain people in the nursing profession, especially in hospice nursing,” as hospice nursing is a particularly intense and stressful field of specialization and burnout and turnover rates among nurses providing hospice care is high (p. 17).

The research question posited by Gaydos (2004) was “What has been your life journey?,” with the “your” referring to the hospice nurses who were the participants in the study. The question is stated broadly enough for a qualitative study; it is open-ended, non-leading, and non-directive, inviting participants to interpret the question according to their own experiences and perceptions. In fact, before reading the outcome of the study, I would have argued that the research question was a bit too broad, as it was not focused specifically on life experiences that affected decisions to become a hospice nurse. Yet, as Polit and Beck (2006) explained, the purpose of qualitative research is often to gather phenomenological information about individuals’ lived experiences, and is therefore inherently exploratory in nature. Future studies on a similar subject can refine the research question and focus it more sharply.

According to Polit and Beck (2006), a study design is the “overall plan for collecting and analyzing data, including specifications for enhancing the internal and external validity of the study” (p. 445). Within the branch of research design that is specifically qualitative, “the design for qualitative studies is an emergent design – a design that emerges as researchers make ongoing decisions reflecting what has already been learned” (p. 210). For this reason, I began to understand, the research question was deliberately broad. The specific methodology and research design that Gaydos (2004) utilized was a design known as cocreative aesthetic inquiry. As Gaydos (2004) explained, “Cocreative aesthetic inquiry is a qualitative method that emphasizes the aesthetic pattern of knowing in nursing” (p. 18). The design involved the use of symbol and narrative to produce a rich data set of information about hospice nurses’ lived experiences.

Polit and Beck (2006) explained that subjects are defined as “a person [or persons] who participates in and provides data for a study; subjects are sometimes designated as SS (e.g., ‘there were 50 ss in the experiment’) (p. 446). Subjects are also known as participants. In the case of this particular study, the subjects were five hospice nurses. As Gaydos (2004) noted, the nurses were all women who ranged in age from 50-73, were Caucasian, and all had at least 10 years of experience as hospice nurses. The nurses varied in terms of their educational background, citizenship, and marital status. The final common characteristic noted by Gaydos (2004) was the fact that all of the nurses were revered highly by their colleagues and peers. The setting of a study is the location in which the study is conducted. The setting of the Gaydos (2004) study varied; initial one-on-one interviews with the subjects were conducted in each subject’s home. Additional interviews were conducted over the telephone. The actual geographical location was not indicated.

Gaydos (2004) clearly indicated that her methodology and research design were intended to elicit symbolic and narrative data of a qualitative nature, and the methods of data collection she selected and implemented were appropriate for fulfilling the goals and objectives of the study. In addition to using the interviews to collect the participants’ own impressions and narratives about their lives, Gaydos’s (2004) approach of conducting the interviews in the participants’ homes allowed her to collect additional data through her own observations. Specifically, Gaydos (2004) examined the objects in the subjects’ environments and used the objects—such as photos or mementoes—to expand the scope of inquiry and, simultaneously, to tailor the broad research question more acutely to each nurse’s own experiences. The data collection methods also allowed the researcher to establish a level of rapport that might have been more difficult to achieve in a different setting.

I was not satisfied, however, with the way in which Gaydos (2004) explained—or, rather, failed to explain—whether the privacy of the subjects was protected and, if so, how. Although one could argue that the administration of the study in each participant’s home increased the participants’ comfort zone and ensured their privacy, it is possible that the participants had not discussed some of their life experiences or motivations about becoming a hospice nurse with other family members. Also, there was no mention as to the methods that were taken to ensure the privacy of other family members. This was an area of the study that could have used more attention.

Regarding data saturation, the evidence that Gaydos (2004) presented is the length of the interviews and the notes she made about her observations of the physical space in a notebook. Gaydos (2004) also took the evidence back to the participants for their review and revision, if applicable. While other evidence could have been provided, the assurance of data saturation in a qualitative study is somewhat more difficult and subjective to achieve compared to a quantitative study.

I was not satisfied with the way in which Gaydos (2004) explained the data analysis procedures. As Polit and Beck (2006) indicated, all steps in a study need to be explained so that the study can be replicated by other researchers. I do not feel that Gaydos (2004) actually explained how the data collected were analyzed, other than saying that she had participants review the data she had collected to affirm its validity and reliability. I do not think that this information provides the level of specificity required to replicate a study based on Gaydos’s model. While the qualitative research design selected is highly subjective and open to interpretation, I do not feel that Gaydos (2004) provided the reader with the tools necessary to determine whether the results were actually valid.

The two major strengths of the study were the selection of the subject of study, which, as Gaydos (2004) explained, is an overlooked subject, and the researcher’s attention and care with respect to allowing sufficient time and varied data collection procedures to gather a rich data set about her subjects. The two major limitations of the study, however, raise certain concerns. As indicated previously, Gaydos (2004) did not provide the reader with a rubric for assessing the data to determine their validity and reliability. Thus, while the study is interesting and may well provide some important insights for the field of nursing, it is difficult both to confirm the data and results, much less to generalize the findings to a larger population of hospice nurses.

I would argue that the scientific merit of this study is not sufficient for considering the application of its findings in professional practice. While the findings are indeed interesting, Gaydos’s (2004) study sample was far too small and her data analysis procedures not elaborated upon enough to determine whether the findings of her study can be generalized to a larger population. Still, the findings of her study could be used as a foundation for further research. Research on this subject should continue to be conducted, either by replicating her study or introducing a new design. Furthermore, Gaydos’s (2004) contribution to the literature by suggesting that the subject is important can raise the profession’s general awareness of the motivations that nurses have for choosing certain specialties.

References

Gaydos, H.L. B.( 2004). The living end. Journal of Hospice & Palliative Nursing, 6(1), 17-26.

Polit, D.F. & Beck, C.T. (2006). Essentials of nursing research (6th ed.). Philadelphia: Lippincott Williams & Wilkins.